Most Often (at 50 % Of Patients) Insufficiency

Most often (at 50 % of patients) insufficiency , leading a reflux-ezofagitu and to a gullet ulcer, observe at hernias diaphragm apertures (the section "Hernias diaphragm apertures" see). Reflux-ezofagit : disease - is caused by repeated influences on a mucous membrane - of a gullet of gastric juice, and also bile, intestinal or - pancreatic juice. A disease current or chronic. Aetiology and : the reason the reflux-ezofagita is zheludochno-pishchevodnyj a reflux which at a part of patients - is connected with infringement of switching function physiological -, at others arises after various surgical - interventions (a resection , , a stomach resection, , etc.), . Peptichesky it is most often observed at - hernias diaphragm apertures, it is frequent at a stomach ulcer of a stomach and a duodenal gut, , a stenosis, a cholecystitis. Pathological anatomy: in mild cases mark moderated and a mucous membrane hypostasis, in heavy - - inflammatory changes not only a mucous membrane, but also subject layers, presence of erosion and , hems, in some cases there is a shortening of a gullet of Change are localised mainly in gullet department, they can be , grasping a considerable part of a mucous membrane of a gullet above , and limited.

The Typical Sign Of Infringement Of A Hernia

The typical sign of infringement of a hernia from , is not present intense hernial However the data (violent reposition of a hernia), a belly-ache, sharp morbidity at soft fabrics in the field of hernial gate, hypodermic hemorrhages allow to assume imaginary reposition of a hernia and urgently to operate the patient. The late complications which observed after spontaneous reposition of restrained hernias and have developed after operations concerning restrained hernias, are characterised by signs of chronic - intestinal impassability (a belly-ache, , humming , splash noise) They formation of solderings of intestinal loops among themselves, with other bodies, with - result - and cicatricial , narrowing a gleam of a gut formation cicatricial intestines occurs on a place from a mucous membrane to the subsequent development of a connecting fabric and its scarring. it is caused by presence in a hernial bag sra-shcheny an internal among themselves, and also with a hernial bag. Development is caused the bodies which are in a hernial bag.

Hernial Gate Dissect - On Obviously Sites. After

Hernial gate dissect - on obviously sites. After cautious - clearing and moving of intestinal loops from a hernial bag it take in. STOMACH AND DUODENAL GUT The stomach is located in the left half of top floor of a belly cavity and its only target department comes to the right for a median plane of a body. On a forward - belly wall the stomach is projected on area left and area, and at stomach filling its big curvature on the top department of umbilical area. In a stomach distinguish a part, a bottom and a body, department, the channel. Border between a stomach and a duodenal gut is . The duodenal gut bends around a head of a pancreas and at a sheaf of Trejttsa forms an excess. The length of this initial department of a small intestine 25 - 30 see In a duodenal gut distinguish three parts top, descending and bottom In a descending part of a duodenal gut on to a wall is located big - a place of a confluence of a gut of the general bilious channel and the main pancreatic channel. Arterial blood supply receives a stomach from branches a trunk.

If There Are No Obvious Signs , The

If there are no obvious signs , the restrained gut is irrigated with a warm isotonic solution of chloride of sodium. It is important to remember that guts begins with a mucous membrane, and change in a gut wall, visible from outside it a cover, appear later. The basic criteria of viability of a small intestine: restoration of normal pink colour of a gut, absence a furrow and subserous hematomas, preservation of a pulsation of small vessels and gut reductions. Indisputable signs of frailty of a gut: dark colouring of a gut, a dim serous cover, a flabby wall of a gut, absence of a pulsation of vessels , absence guts. The fifth stage - an impractical gut should be deleted. From visible from outside a border cover it is necessary not less than 30 - 40 sm of a resulting piece of a gut and 15 - 20 sm of a taking away piece. The gut resection should be made at detection in a gut wall furrows, subserous hematomas, the big hypostasis, and hematomas guts. At infringement of sliding hernias there is a necessity for an estimation of viability of that part of body which is not covered .

In An Average - Part Of Chest Department

In an average - part of chest department it deviates to the right an average line and lies to the right of an aorta, and in the bottom third of chest department again deviates to the left an average line and over a diaphragm is located in front from an aorta. Such anatomic arrangement of a gullet dictates corresponding operational access to its various departments - to cervical link sided, to - right-hand , to - link sided transpleural. The place of transition of a gullet in a stomach is called . The left wall of a gullet and a stomach bottom form a corner of Gisa. Gullet wall form four layers - mucous, , muscular and external a cover. The mucous membrane is formed multilayered flat which passes in cylindrical gastric at level of the gear line located some above anatomic . The podslizistyj layer is presented and by fibres. Muscular, the cover consists of internal circular and external longitudinal fibres between which large vessels and nerves in top 2/3 of gullet of a muscle are located, in the bottom third muscular cover consists of smooth muscles.

If It Is Possible, Expedient To Arrange Seed

If it is possible, expedient to arrange seed between rags an external slanting muscle of a stomach FEMORAL HERNIAS Femoral hernias settle down on a hip in area skarpov-skogo a triangle On frequency of formation they make 5 - 8 % of all hernias of a stomach Femoral hernias meet less often and happen mainly at women Among patients to femoral - hernias of the woman at the age of 30 - 60 years make 80 % the - Greatest frequency of femoral hernias at women explain wider basin that causes the big expressiveness - of muscular and vascular lacunas and smaller durability sheaves. Between a sheaf and basin bones it is located which is divided podvzdoshno-grebeshkovoj by a sheaf on two lacunas muscular and vascular In a muscular lacuna there is a lumbar muscle and a femoral nerve. In a vascular lacuna are located a femoral artery with a femoral vein. Between a femoral vein and the interval filled with a fibrous connecting fabric and a lymph node of Pirogiva - Rozenmjullera is available a sheaf. This interval name a femoral ring through which there is a femoral hernia.

The Edge Of An Internal Aperture The Channel

The edge of an internal aperture the channel is outlined accurately thanks to arcuate fibres ligamentum Hesselbachu. On a place of an internal aperture the channel cross-section it is funneled bent and passes on seed , forming the general a cover seed and . Round the sheaf at level of an external aperture the channel is divided into the fibres which part terminates on bones, another in hypodermic areas. Congenital hernias. If the shoot - remains completely , its cavity is freely informed with a cavity . Further the hernia at which the shoot is a hernial bag is formed congenital . Congenital hernias make a - great bulk of hernias at children (90 %). However and at adults happen congenital hernias (nearby 10 - 12 %). Got hernias. Distinguish slanting external a hernia and direct (internal) a hernia. Slanting the hernia passes through external a pole; a straight line - through medial a pole. In an initial stage of development slanting hernias approximately hernial it is imperceptible. At or a tussiculation of the patient the - swelling quickly disappearing after only the patient is defined the oval form stops , at the channel form the bottom of a hernial bag reaches an external aperture - the channel.

During A Finding Write In A Stomach Two

During a finding write in a stomach two types of movements are observed: tonic and . Muscles of a body of a stomach put constant weak pressure upon its contents-. Separate waves mix food with juice glands and move it in department At this time and densely closes an exit from a stomach. The reflux gastric contained - in a gullet prevents the difficult physiological switching - mechanism promoting closing of pishchevodno-gastric transition. The food lump moves in department which deep interception waves separates from a cavity of a body of a stomach. Further the wave in the form of rings extends in a direction. There is a - crushing of a food lump, its mixing to an alkaline secret glands When the wave reaches the gatekeeper, it relaxes, the part contained department arrives in a duodenal gut Then the gatekeeper becomes isolated, there is a total reduction of walls department. The high pressure in department forces contained to move in the opposite direction to a cavity of a body of a stomach where it again is exposed to influence - of hydrochloric acid and .

At And Vomitings Probably Hit Of Food Weights

At and vomitings probably hit of food weights in a tree and development of heavy inflammatory pulmonary complications. The clinical - clinical course depends on level of defeat of a gullet. The cancer and cervical departments of a gullet proceeds especially painfully. In the beginning patients complain of sensation of a foreign matter, a scratching, burning in a gullet during meal. Later there are symptoms of pharyngeal insufficiency - frequent -, , attacks . At a cancer gullet department quite often on the first place acts , then there are symptoms of germination - of a tumour in the next bodies and fabrics (roots of lungs, the chest lymphatic channel wandering and sympathetic nerves, a - backbone, etc.). These patients have heavy complications: , traheo - and fistulas, bleedings, a pleurisy, etc. of which they also die. The cancer of the bottom third of gullet is shown often by pains in areas, in the left half of thorax and feigning a stenocardia. The origin of similar pains is connected with germination by a tumour a nerve.

At Carrying Out Of The Differential Diagnosis Of

At carrying out of the differential diagnosis of a cancer of a gullet it is necessary to exclude other diseases accompanied : , cicatricial narrowings after chemical - burns, good-quality stenoses at patients with and gullet ulcers, good-quality tumours, a tuberculosis. The differential diagnosis with see in section "Ahalazija ". For after a burn, a gullet trauma the anamnesis is characteristic-. At radiological research gullet contours - wavy, narrowing extends on the big extent. To patients - it is shown for an exception . Patients with and gullet ulcers in the anamnesis have instructions on presence of a stomach ulcer, a hernia apertures of a diaphragm and other diseases - accompanied by symptoms a reflux-ezofagita. The great value For differential diagnostics has with -. At good-quality gullet tumours accrues very slowly throughout many years. The general condition of patients is not broken. Radiological and - researches specify in absence of changes - of a mucous membrane of a gullet.

The First Period - Painful, Or The Shock,

The first period - painful, or the shock, second period - imaginary well-being, the third period - the poured peritonitis. For the first period the sharpest pain which causes the shock phenomena is characteristic. Pulse weak frequent, arterial pressure is lowered, breath becomes frequent and superficial. This period happens is expressed at to the infringement form. In imaginary well-being there is a reduction of a pain which was before very intensive. It can mislead the doctor and the patient accepting reduction or disappearance of a pain for improvement of a current of disease-. It is possible to explain pain reduction the restrained - loop of a gut. However local displays of infringement of a hernia remain. If patient do not operate, its condition quickly worsens, there comes the third period of the poured peritonitis. The body temperature - raises, pulse becomes frequent. The stomach swelling increases, - there is a vomiting. Puffiness in the field of hernial increases, appears skin, the - phlegmon develops-.

Big A Tumour, The Bleeding Is Possible-. A

Big a tumour, the bleeding is possible-. a gullet can . Owing to having handed over-livanija to a tumour of bodies - (tracheas, bronchial tubes, the hearts-, wandering nerves) - can arise cough, a short wind, , palpitation, pains in the field of heart, and - other frustration. Probably malignant regeneration of good-quality tumours and a gullet. The diagnosis of a good-quality tumour of a gullet put on the basis of the analysis of a clinical - picture of disease, the - data of radiological - research and . For good-quality tumours of a gullet following - radiological - signs are characteristic--: accurate equal contours of defect of the filling which is settling down on one of walls of a gullet, a relief of a mucous membrane and elasticity - of walls of a gullet in the field of defect, an accurate corner between a wall of a gullet and tumour edge ("a peak" symptom). At - cinema research good-quality formation - of a gullet at swallowing is displaced up together with a gullet wall. For an exception a gullet from the outside a new growth which is starting with , or it is abnormal the located large - arterial vessel use and .

Reflex Pressure Of Muscles Comes Out Irritation -

Reflex pressure of muscles comes out irritation - of the termination of intercostal nerves in and intestines. The patient avoids movement as - position change - strengthens a pain. At the morbidity zone, pressure of muscles of a belly wall, is defined by corresponding intercostal nerves. Concussion of a belly wall causes morbidity. Transition pains in somatic is the disturbing sign specifying in transition of inflammatory process from one of an internal on . Transition example pains in somatic - is the acute appendicitis current. In the disease beginning when the inflammation is limited to a shoot, the patient - feels the poured dull ache round a navel, at this time there is no pressure of muscles of a belly wall. At inflammation transition on a shoot and the pain is localised in right areas, becomes sharp, there is a pressure of muscles and morbidity at in right areas. At inquiry of the patient about a belly-ache it is recommended to put questions and to receive on them answers in such sequence: what? Where? When? Why? Question "that disturbs?" Find out character of a pain on which - it is possible to judge the amazed layers of a wall of body.

A Disease Current Slow, Without - Essential Progressing.

A disease current slow, without - essential progressing. Tsenkerovsky can become complicated development which in turn can become the reason - of a phlegmon of a neck, , developments a fistula, a sepsis. and contents lead to a chronic bronchitis, to a repeated pneumonia, abscesses of lungs Are possible a bleeding from a mucous membrane -, development in it of polyps, its walls. At a long delay of food weights in and there can be complications: , an abscess with break in a bronchial tube, a gullet, a pericardium and other bodies , the massive bleeding Chronic contributes to cancer occurrence. Glotochno-pishchevodnye sometimes it is possible to find out at survey and necks. The basic method of diagnostics - a gullet is the contrast radiological - research establishing presence , width of a neck, duration of a delay in it of barium, degree of infringement of passableness - of a gullet, development signs in a polyp and a cancer, formation pishchevodno-bronchial and fistulas. Endoskopichesky research gives the chance to establish presence , to find out its mucous membrane-, bleeding presence, to diagnose a polyp or a cancer in -.

It Is Possible To Carry Ruptures Of Large

It is possible to carry ruptures of large vessels, a separation of lateral branches, rupture to consequences of a stupid trauma of a stomach aorta aneurysms. These damages are accompanied by a massive intrabelly - bleeding and in some cases can end with death of the patient from a shock. At a trauma of the bottom department of a stomach - bladder rupture -(is possible - at the filled bladder). At rupture of a bladder the urine expiration in free the cavity quickly causes development of the poured peritonitis. bladder rupture is often combined with heavy crises of bones of a basin with displacement . Almost always such traumas are accompanied and frustration up to a sharp delay of urine. At damage of an extrabelly part of a bladder on the first place frustration and infectious complications (uric become numb) act. An additional method of diagnostics is . Inspection of the patient with a stupid trauma of a stomach begin with survey at which already external signs of a trauma (hypodermic and intraskin hemorrhages) can serve as the first instructions - for diagnosis statement So, hypodermic hemorrhages in left , a sharp pain in this area with in left allow to assume spleen damage, a pain in right with in right - forces to suspect liver damage.